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Journal of Clinical Oncology, Vol 22, No 2 (January 15), 2004: pp. 379-380 © 2004 American Society of Clinical Oncology. DOI: 10.1200/JCO.2004.99.163
The Prognostic Significance of Indium-111–Capromab PenetideCase Western Reserve University, Cleveland, OH To the Editor: In a recent study of the prognostic significance of indium-111–capromab pendetide (ProstaScint; Cytogen Corporation, Princeton, NJ) for imaging patients with prostate cancer who underwent salvage radiotherapy (RT) for recurrent disease after prostatectomy, Thomas et al [1] reported that presalvage RT imaging outside the prostate fossa was not predictive of biochemical control post-RT. Since this conclusion conflicts with the results reported by us [2] and several others groups [3,4], and because this imaging procedure is widely used to guide RT as well as to stage prostate cancer, we are compelled to apprise oncologists and urologists that the imaging technology used by Thomas et al did not adhere to the state of the science. Thus, the conclusions reached should not be assumed to apply to capromab pendetide imaging generally. The protocol used by Thomas et al [1] was attributed to one of the authors of this letter [5] in which preliminary imaging results were reported in 1996. Vast technical improvements have been made in capromab pendetide imaging during the last 7 years, much of which can be attributed to the burgeoning growth of computer power which permits image-processing to be routinely done today but was nonexistent a decade ago when the study by Sodee et al [5] was initiated. This great computer power permits more sophisticated image acquisition and processing to be done which, in turn, frequently changes a positive result to negative and vice versa. For example, the 64 x 64 matrix used for single photon emission computed tomography (SPECT) imaging by Thomas et al was noted in our previous multicenter study [2] to be woefully inadequate relative to 128 x 128 acquisitions that are now routinely used. Iterative SPECT reconstruction techniques with two- and three-dimensional beam models and attenuation correction are now also available to facilitate accurate localization of cancer. Perhaps the greatest deficiency in the study by Thomas et al [1] is their failure to use image coregistration which permits the functional images of capromab pendetide uptake to be synergistically combined with the anatomic detail of computed tomography (CT) to yield a fused image that unequivocally delineates where uptake occurs both within the prostate and in the pelvic and abdominal nodes. This can be routinely done using commercially available software that facilitates image registration, reducing the time required to a matter of minutes. Conducting capromab pendetide imaging without CT coregistration is tantamount to depriving the prostate cancer patient of the best means available to evaluate his disease. The importance of image coregistration is perhaps most vividly illustrated by the mushrooming growth of positron emission tomography/CT in the last few years, which is demonstrated by one of the coauthors of Thomas et al, who presented more than 10 abstracts on this subject at the 2003 Meeting of the Society of Nuclear Medicine (New Orleans, LA, June 21 to 25, 2003). We urge the urologists and oncologists among your readers to question the conclusions derived from the cursory imaging study of Thomas et al [1] and instead to request fused capromab pendetide/CT imaging and currently available image-processing techniques to permit optimum staging of their patients' prostate cancer. Authors' Disclosures of Potential Conflicts of Interest The following authors or their immediate family members have indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. Acted as a consultant within the last 2 years: D.B. Sodee, Cytogen Corporation; A.D. Nelson, Cytogen Corporation. Performed contract work within the last 2 years: D.B. Sodee, Cytogen Corporation; A.D. Nelson, Cytogen Corporation; P.F. Faulhaber, Cytogen Corporation; G. Bakale, Cytogen Corporation. Received more than $2,000 a year from a company for either of the last 2 years: G. Bakale, Cytogen Corporation. REFERENCES
1. Thomas CT, Bradshaw PT, Pollock BH, et al: Indium-111-capromab pendetide radioimmunoscintigraphy and prognosis for durable biochemical response to salvage radiation therapy in men after failed prostatectomy. J Clin Oncol 21:1715-1721, 2003 2. Sodee DB, Malguria N, Faulhaber P, et al: Multi-center ProstaScint findings in 2154 patients with prostate cancer. Urology 56:988-993, 2000[CrossRef][Medline]
3. Kahn D, Williams RD, Hasemann MK, et al: Radioimmunoscintigraphy with In-111-labeled capromab pendetide predicts prostate cancer response to salvage radiotherapy after failed prostatectomy. J Clin Oncol 16:284-289, 1998 4. Levesque PE, Nieh PT, Zinman LN, et al: Radiolabeled monoclonal antibody indium 111-labeled CYT-356 localizes extraprostatic recurrent carcinoma after prostatectomy. Urology 51:978-984, 1998[CrossRef][Medline] 5. Sodee DB, Conant R, Chalfant M, et al: Preliminary imaging results utilizing indium-111 labeled CYT-356 (ProstaScint®) in the detection of recurrent prostate carcinoma. Clin Nucl Med 21:759-767, 1996[CrossRef][Medline]
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Copyright © 2004 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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